Breast Augmentation
(Breast Implant)

Achieve the look you desire

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    Breast Augmentation (Breast Implant)

    Achieve the look you desire
    Breast – Anatomy
    • Breast augmentation using implants has been an established procedure with a long historical record of safety.
    • It is the most assured and quickest way to achieve the desired breast volume.
    • The use of implants is one of the best breast enhancement surgery options available in Singapore.

    Breast augmentation is Frequently done with

    • Nipple reduction
    • Mommy make-over – abdominoplasty combined with breast augmentation
    • Mastopexy
    • Here are some of the most important factors to be considered :
      1. Size of the Implant
      2. Type of Implant : Saline vs Silicone
      3. Shape of Implant
      4. Surface of Implant
      5. Surgical Incision
      6. Placement of Implant
    • Dr. Ng’s experience with Asian patients, the most common request is for teardrop shaped silicone implants, sized between 200-300ml placed via inframammary incision into the sub-pectoral pocket.
    • Here are some of the most important factors to be considered :
      1. Size of the Implant
      2. Type of Implant : Saline vs Silicone
      3. Shape of Implant
      4. Surface of Implant
      5. Surgical Incision
      6. Placement of Implant
    • Dr. Ng’s experience with Asian patients, the most common request is for teardrop shaped silicone implants, sized between 200-300ml placed via inframammary incision into the sub-pectoral pocket.
    • The size of the implant should be in proportional to body stature, height and chest circumference.
    • It is also determined by width of breast base, amount of breast tissue and skin elasticity.
    • Placing excessively large implants will result in an unnatural appearance if there is insufficient tissue coverage.
    • During the consultation, you can try a variety of implant sizes to simulate the final outcome.

    Silicone Breast Implant – Cohesive Gel

    Saline Silicone
    Popularity
    Saline
    • Less popular
    Silicone
    • More popular
    Texture
    Saline
    • Less natural feel
    Silicone
    • More natural feel
    Shell Wrinkling
    Saline
    • Common
    Silicone
    • Rare
    Implant Volume
    Saline
    • Adjustable
    Silicone
    • Fixed
    Adjustment to body temperature
    Saline
    • Adjust quickly
    Silicone
    • Adjust slowly (e.g. the implant remains cold for a longer duration after a swim)
    Contracture Rate
    Saline
    • Low
    Silicone
    • Higher
    Leakage
    Saline
    • Leakage causes complete deflation but safely absorbable
    Silicone
    • Leakage may cause local inflammation and granulomas, but much safer for modern cohesive gel implants
    Round/ Circular Anatomical/ Teardrop
    Profile
    Round/ Circular
    • Dome shaped – less natural appearance
    Anatomical/ Teardrop
    • Tear drop shape – more natural appearance
    • Large variety of shapes based on different height and projections
    Implant Orientation
    Round/ Circular
    • Less crucial
    Anatomical/ Teardrop
    • Very crucial
    Incision
    Round/ Circular
    • More options for incision
    Anatomical/ Teardrop
    • Usually inframammary incision

    Breast implant : Choice of Incisions

    Inframammary Periareolar Axillary Trans-umbilical
    Scar
    Inframammary
    • Scar well-hidden within breast fold
    Periareolar
    • Scar at areolar margin – may result in hypertrophic scars
    Axillary
    • Hidden in the armpit crease but visible when wearing sleeveless
    Trans-umbilical
    • Well hidden in the umbilicus
    Accuracy of implant placement
    Inframammary
    • Direct visualization of orientation of implant
    • Best accuracy for all implant placement
    Periareolar
    • Reasonably accuracy of implant placement
    Axillary
    • More difficult to ascertain the orientation of implant
    Trans-umbilical
    • Least accurate placement of implant
    Limitations on implants
    Inframammary
    • No limitations
    Periareolar
    • Limit choice of implant size if areolar diameter is < 3.5- 4 cm
    Axillary
    • Difficulty with teardrop shape implant
    Trans-umbilical
    • Suitable only for saline implant not for silicone implants
    Breastfeeding
    Inframammary
    • Not affected
    Periareolar
    • Can be affected
    Axillary
    • Not affected
    Trans-umbilical
    • Not affected
    Remarks
    Inframammary
    • Most popular approach for tear drop shape silicone implant
    Periareolar
    • May cut through breast tissue to allow implant placement
    • Risk of nipple numbness
    Axillary
    • Risk of skin numbness around armpits and upper arm
    • Difficult to lower inframammary fold if needed
    Trans-umbilical
    • Difficult and blind dissection
    • High or asymmetrical implant placement
    Textured Smooth
    Contracture Rates
    Textured
    • Lower
    Smooth
    • Higher
    Implant Migration
    Textured
    • Infrequent
    Smooth
    • Common
    Shell Thickness
    Textured
    • Thicker – maybe palpable
    Smooth
    • Thinner – less palpable

    Polyurethane (PU) -covered implant – had very low contracture rate, but has been withdrawn because of a carcinogenic compound from PU breaking down (although at very low levels).

    Sub-glandular Sub-pectoral
    Diagram
    Sub-glandular

    Breast implant – Sub-mammary placement

     
    Sub-pectoral

    Breast implant – Sub-pectoral placement

     
    Placement
    Sub-glandular
    Implant underneath breast tissue, above pectoris major muscle – is more anatomical
    Sub-pectoral
    Implant underneath pectoralis muscles – is less anatomical
    Suitable Candidates
    Sub-glandular
    For patient with sufficient original breast tissue – result can be very natural
    Sub-pectoral
    For patient with very little breast tissue –pectoralis major muscle provides additional coverage to camouflage edge of implant.
    Natural Appearance
    Sub-glandular
    More natural appearance if there is sufficient breast parenchymal
    Sub-pectoral
    Better appearance for those patients with very little breast parenchymal
    Capsular Contracture
    Sub-glandular
    Higher risk
    Sub-pectoral
    Lower risk
    Nipple Sensation
    Sub-glandular
    Maybe affected
    Sub-pectoral
    Not affected
    Implant Size Limitation
    Sub-glandular
    Allow larger implant
    Sub-pectoral
    Implant size limited by size of subpectoral pocket
    Limitation of activity
    Sub-glandular
    Not likely
    Sub-pectoral
    Chest muscles contraction may cause implant to shift laterally (“dancing breast”)
    Recovery
    Sub-glandular
    Slightly less pain
    Sub-pectoral
    Slightly more pain

    • It is advisable to consult an experienced plastic surgeon before proceeding with the surgery.
    • Here are some of the most important factors to be considered :
      1. Size of the Implant
      2. Type of Implant : Saline vs Silicone
      3. Shape of Implant
      4. Surface of Implant
      5. Surgical Incision
      6. Placement of Implant
    • Dr. Ng’s experience with Asian patients, the most common request is for teardrop shaped silicone implants, sized between 200-300ml placed via inframammary incision into the sub-pectoral pocket.
    • Here are some of the most important factors to be considered :
      1. Size of the Implant
      2. Type of Implant : Saline vs Silicone
      3. Shape of Implant
      4. Surface of Implant
      5. Surgical Incision
      6. Placement of Implant
    • Dr. Ng’s experience with Asian patients, the most common request is for teardrop shaped silicone implants, sized between 200-300ml placed via inframammary incision into the sub-pectoral pocket.
    • The size of the implant should be in proportional to body stature, height and chest circumference.
    • It is also determined by width of breast base, amount of breast tissue and skin elasticity.
    • Placing excessively large implants will result in an unnatural appearance if there is insufficient tissue coverage.
    • During the consultation, you can try a variety of implant sizes to simulate the final outcome.

    Silicone Breast Implant – Cohesive Gel

    SalineSilicone
    Popularity
    • Less popular
    • More popular
    Texture
    • Less natural feel
    • More natural feel
    Shell Wrinkling
    • Common
    • Rare
    Implant Volume
    • Adjustable
    • Fixed
    Adjustment to body temperature
    • Adjust quickly
    • Adjust slowly (e.g. the implant remains cold for a longer duration after a swim)
    Contracture Rate
    • Low
    • Higher
    Leakage
    • Leakage causes complete deflation but safely absorbable
    • Leakage may cause local inflammation and granulomas, but much safer for modern cohesive gel implants
    Round/ CircularAnatomical/ Teardrop
    Profile
    • Dome shaped – less natural appearance
    • Tear drop shape – more natural appearance
    • Large variety of shapes based on different height and projections
    Implant Orientation
    • Less crucial
    • Very crucial
    Incision
    • More options for incision
    • Usually inframammary incision

    Breast implant : Choice of Incisions

    InframammaryPeriareolarAxillaryTrans-umbilical
    Scar
    • Scar well-hidden within breast fold
    • Scar at areolar margin – may result in hypertrophic scars
    • Hidden in the armpit crease but visible when wearing sleeveless
    • Well hidden in the umbilicus
    Accuracy of implant placement
    • Direct visualization of orientation of implant
    • Best accuracy for all implant placement
    • Reasonably accuracy of implant placement
    • More difficult to ascertain the orientation of implant
    • Least accurate placement of implant
    Limitations on implants
    • No limitations
    • Limit choice of implant size if areolar diameter is < 3.5- 4 cm
    • Difficulty with teardrop shape implant
    • Suitable only for saline implant not for silicone implants
    Breastfeeding
    • Not affected
    • Can be affected
    • Not affected
    • Not affected
    Remarks
    • Most popular approach for tear drop shape silicone implant
    • May cut through breast tissue to allow implant placement
    • Risk of nipple numbness
    • Risk of skin numbness around armpits and upper arm
    • Difficult to lower inframammary fold if needed
    • Difficult and blind dissection
    • High or asymmetrical implant placement
    TexturedSmooth
    Contracture Rates
    • Lower
    • Higher
    Implant Migration
    • Infrequent
    • Common
    Shell Thickness
    • Thicker – maybe palpable
    • Thinner – less palpable

    Polyurethane (PU) -covered implant – had very low contracture rate, but has been withdrawn because of a carcinogenic compound from PU breaking down (although at very low levels).

    Sub-glandularSub-pectoral
    Diagram
    Breast implant - Sub-mammary placement Breast implant – Sub-mammary placement
    Breast implant - Sub-pectoral placement Breast implant – Sub-pectoral placement
    PlacementImplant underneath breast tissue, above pectoris major muscle – is more anatomicalImplant underneath pectoralis muscles – is less anatomical
    Suitable CandidatesFor patient with sufficient original breast tissue – result can be very naturalFor patient with very little breast tissue –pectoralis major muscle provides additional coverage to camouflage edge of implant.
    Natural AppearanceMore natural appearance if there is sufficient breast parenchymalBetter appearance for those patients with very little breast parenchymal
    Capsular ContractureHigher riskLower risk
    Nipple SensationMaybe affectedNot affected
    Implant Size LimitationAllow larger implantImplant size limited by size of subpectoral pocket
    Limitation of activityNot likelyChest muscles contraction may cause implant to shift laterally (“dancing breast”)
    RecoverySlightly less painSlightly more pain
    • It is advisable to consult an experienced plastic surgeon before proceeding with the surgery.

    About DR. NG SIEW WENG
    (伍修永医生)

    Dr Ng Siew Weng is a Consultant Plastic & Reconstructive Surgeon accredited by the Specialists Accreditation Board, Ministry of Health of Singapore. He graduated from the Medical Faculty of the National University of Singapore and pursued several Post Graduate Diploma programs, two of which were in Dermatology.

    He was the first plastic surgeon from Singapore General Hospital (SGH) to receive the HMDP scholarship by the Ministry of Health to train in South Korea.

    During his training in South Korea, Dr Ng worked with world-renowned top plastic surgeons. His surgical techniques have a strong Korean influence especially in popular procedures like rhinoplasty, breast augmentation, blepharoplasty (double eyelid surgery), eyebag removal, droopy eyelid (ptosis) correction, facelift and fat grafting

    Our Philosophy

    Dr Ng Siew Weng is active in the field of research, as reflected by the numbers of research papers he published, and the several invitations he received to present at medical conferences in North America, Europe and Asia including Singapore. During his attachment at the Hand Surgery Department in SGH, he received a prestgious Economic Development Board Proof of Concept Grant to investigate the treatment of trigger finger and subsequently invented a novel treatment device which is patented.

    Dr Ng has also researched into stem cells and demonstrated that stem cells derived from autologous adipose tissue improved the rate of wound healing. Dr Ng’s research interest in fat stem cells has led him to use it in clinical practice in order to achieve the best cosmetic results.

    He uses fat grafting regularly in his surgery to achieve natural cosmetic enhancement such as fat gratfing to breast and fat grafting to face. He had organised a Fat Grafting Workshop at SGH so that local surgeons have the opportunities to learn fat grafting techniques from him and a top Korean surgeon.

    During his attachment at the Hand Surgery Department in SGH, he received rigorous microsurgery training which is invaluable for honing his techniques in facial and breast reconstruction .

    Our Clinic is a fully equipped, Ministry of Health accredited Ambulatory Surgical Centre as well as state-of-the-art health care facilities. We aim to provide a safe and comfortable environment so that our patients can have their best possible experience when receiving cosmetic surgery in Singapore.

    Our main clinic is located at Farrer Park Medical Centre, Connexion – a three-in-one medical tourism friendly complex that comprises of Farrer Park Medical Centre, Farrer Park Hospital and One Farrer Hotel and Spa. A first of its kind in Asia, patients have the option of recovering in the comfort of a 5-star hotel or hospital after surgery. Our team would be glad to arrange concierge service and hotel stay is required. To serve our patients better, we have a branch in Gleneagles Medical Centre.

    Having practised the art of plastic surgery for many years, Dr Ng often shares some of his personal philosophies with his patients during consultation. Many of these principles are interrelated.

    “There is no shortcut to perfection”

    Most patients have high expectations when they plan to undergo cosmetic surgery. They aspire to obtain great results, but all too often unwilling to tolerate the journey to get there. To achieve a harmonious appearance, a combination of procedures may need to be done simultaneously to address various features of the patient.

    We often fail to give due recognition to those patients who have the fortitude and courage to undergo multiple procedures to achieve their dream looks. It is similar to extreme hard work to score straight As in studies.

    “Less is more, more is less – harmony is most important”

    Cosmetic surgery patients do not wish to exhibit any tell-tale sign of surgery. Most patients think that undergoing the least number of surgical procedures would avoid this problem. For example, patients presenting with eyebags often also have ageing upper eyelids. Eyebags removal alone may make the upper eyelid appear out of sync after surgery. Therefore, both upper and lower lids procedures can be planned together – a combination of procedures may produce less tell-tale sign resulting in a more synchronized and harmonious appearance.

    “Plastic surgery should not be addictive if well planned”

    Based on experience, we frequently observe that a single surgical procedure to one area of the face can potentially cause the neighbouring areas to appear out of sync.

    Some patients only focus on correcting the features they are most dissatisfied with; not realizing that any minor changes of a particular feature may affect adjacent features.

    After the first surgery, the patient may very soon undergo another surgery to achieve harmony with the surrounding area. This continuous catching up gives the connotation of “surgery addiction”. This can be avoided if several well-planned procedures are carried out at the outset.

    A nose job (rhinoplasty) which improves the nose shape, projection and length may emphasize a pre-existing small chin. To achieve a harmonious look, Dr Ng would suggest a procedure to improve the chin projection to match the nose.

    However it may not possible at times to adopt a holistic approach because of : (1) patient’s resistance, (2) surgeon’s fear of being labelled as overselling, (3) financial constrain etc.

    “Don’t be afraid to change”

    Patients very often say “I don’t want any obvious changes.” If the patient’s relatives cannot perceive a difference post surgery, the procedure would not have yielded any result.

    The ideal outcome would be : definite changes and improvement noticed by the patient’s relatives ; but a stranger who meets the patient the first time should think that the patient looks great without suspecting any surgery being done.

    It is important not to be afraid to undergo a change if it is for the better.

    Dr Ng believes that most patients want to retain some semblance of their original appearance. He will strive to enhance what they already have rather than change their identity unless it is their intention.

    “Plastic surgery should be carefully considered because it may not be reversible”

    We must be aware that surgery result can be permanent and irreversible. It is best to read widely about the intended procedure and speak in detail with a few experts before deciding.

    Many people have the false sense of security that simple surgery would not go wrong since they are commonplace. There are many incidences of simple eyelid surgery with undesirable results that are very difficult to correct completely. There is a tendency to trivialise cosmetic surgery. Dr Ng is most worried about the group of patients who refuse to explore details and commit to surgery hastily .

    Dr Ng believes in providing sufficient information and management options for the patient to make an informed decision. The patient needs to clearly understand : (1) The nature of their current condition, (2) The whole range of management options : from non-invasive to operative solutions, and (3) The pros and cons of each option.

    Most patients find this approach helpful. Dr Ng often reiterates that his role is to provide guidance, highlight to the patient if the choice of treatment is incorrect, but the final decision still lies with the patient.

    He normally provide a summary list of best plastic surgery procedures that is suited for the patient. It is difficult to balance between providing detailed information and being mistaken for overselling.

    Dr Ng had been active in the training of doctors and residents while he was Visiting Consultant at the Singapore General Hosipital (SGH). He was also an Adjunct Assistant Professor at the Duke-NUS Graduate Medical School. He hopes that training and knowledge sharing would produce the best plastic surgeons in Singapore.

    Despite Dr Ng’s hectic schedules, he had volunteered in humanitarian trips to perform free surgeries to correct cleft lip and/or palate, post-traumatic or burns deformities in Laos, Indonesia, China and Uzbekistan.

    What can I expect from consultation to recovery?

    Step 1

    Pre-operative sizing during consultation :

    • Patient to try multiple implant sizes to simulate the final outcome.

    Step 2

    Pre-operative screening includes: blood test and breast imaging (ultrasound, mammogram)

    Step 3

    On surgery day

    • Pre-operative marking includes planning of the new inframammary fold and incision.
    • Incision at new inframammary fold
    • Dissection to create space either a sub-glandular or sub-pectoral pocket for implant placement.
    • Insertion of implant.
    • Meticulous wound closure in multiple layers.

    Step 4

    Support bra are worn immediately after surgery

    Step 5

    Follow-up review sessions

    What can I expect from consultation to recovery?

    Step 1

    Pre-operative sizing during consultation

    Pre-operative sizing
    during consultation

    • Patient to try multiple implant sizes to simulate the final outcome.

    Step 2

    Pre-operative screening includes: blood test and breast imaging (ultrasound, mammogram)

    Step 3

    On surgery day​

    On surgery day

    • Pre-operative marking includes planning of the new inframammary fold and incision.
    • Incision at new inframammary fold
    • Dissection to create space either a sub-glandular or sub-pectoral pocket for implant placement.
    • Insertion of implant.
    • Meticulous wound closure in multiple layers.

    Step 4

    Support bra are worn immediately after surgery

    Support bra are worn
    immediately after surgery

    Step 5

    Follow-up review sessions

    BOOK AN APPOINTMENT

      After consultation, Dr Ng would explain the most common breast enhancement options. He would recommend the best breast implant surgery method used by some of the top plastic surgeons including those in Korea.

      Frequently Asked Questions

      • Dr Ng prefers general anaesthesia for greater patient comfort and safety.
      • In order to create a sub-pectoral pocket for insertion of the implant, the chest muscles need to be relaxed. This may compromise the patient’s breathing capability if done under deep sedation. General anaesthesia is safer because continuous oxygen delivery to the patient is ensured throughout the surgery.
      • Home on the same day
      • Medication includes : antibiotics, pain relief and medication to reduce swelling and bruising.
      • Support bra to prevent implant from displacing laterally or riding high. The patient wears this bra for at least a month depending on the clinical outcome.
      • Back to work (non-strenuous) within 2-3 days.
      • Stitches (if any) are removed in about 2 weeks.
      • Breast massage :
        • Initiated from 2-3 weeks onwards to further improve the final appearance.
        • Usually the direction of massage is downwards and inwards. This may differ depending on clinical status.
      • Scar management :
        • Scar massage to soften the scar
        • Scar gel application to prevent scar thickening and reduce redness.
        • Photo Therapy to further reduce pigmentation.
      • Exercise :
        • Light exercise can be restarted after 1 month.
        • Avoid exercise that involved heavy usage of the pectoralis muscles for at least 2 -3 months.
      • Appearance of breast :
        • It is normal to expect swelling and tightness over the breast for the first 1-2 weeks. During this period of time the implant may feel more stiff and firm. The breast tissue covering the implants stretches over the next 2-3 months, the implants will feel softer and more natural.
        • Final appearance is usually achieved from 3 months onwards.
      • Bleeding and infection are uncommon.
      • Infection is kept to minimal by the use of antibiotics, good surgical techniques and having the surgery done in a sterile operation room.
      • Synmastia
        • Is a condition where both breast tissues were merged across the sternum due to over dissection during breast augmentation.
      • Implant rupture is very low risk due to modern day implants.
      • Implant displacement
      • Seroma
      • Capsular contracture
      • Breast reconstruction using implant post mastectomy due to breast cancer may be considered as a non-cosmetic procedure.
      • Silicone breast implants have been used for several decades for cosmetic as well as reconstructive purpose. They have a good safety record despite temporarily banned for cosmetic usage in the United States for possible association with connective tissue disease. This was found to be untrue and the ban was lifted.
      • The size of the implant has to be proportional to the patient’s body stature, height and chest circumference. It is also determined by the width of breast base, amount of breast tissue and skin elasticity. Placing of excessively large implants will result in an unnatural appearance if there is insufficient tissue coverage.
      • In most cases, the scar ranges from 3.5 to 4.5 cm depending on the size of implant chosen. It would be unwise to place a very large implant through the narrowest incision – implant rupture during surgery rarely occur. During the consultation Dr Ng shall illustrate this point.
      • Through a very small incision, the dissection of implant pocket and the control of bleeding (haemostasis) is much more difficult.
      • During dissection of the implant pocket, it is conventional to keep about a 3 cm wide spacing of central chest tissue intact. This is to prevent over dissection which can result in the breast pockets from both sides communicating with each other (synmastia). This is a very difficult complication to rectify.
      • The silicone implant theoretically can last indefinitely i.e. the silicone in the implant does not harden over time. As long as there is no significant capsular contracture there is no need to replace the implant.
      • The body naturally produces a thin membrane (capsule) around any implanted foreign object, this membrane normally remains thin and pliable. In some patients significance scarring occurs in the membrane in this capsule, causing the whole construct to appear stiff and hardened (capsular contracture).
      • The severity of capsular contracture has been classified by Baker (1980)
      • Breast augmentation should not interfere with breastfeeding as long as milk ducts are not cut. Other than peri-areoalar incision there is very low chance of affecting breastfeeding.
      • After breast augmentation, cancer screening can still be performed using ultrasound, mammography, MRI scan. There are special mammographic views (Eklund Displacement) available for better visualization after breast augmentation.

      What Our Patients Say

      BOOK AN APPOINTMENT

        After consultation, Dr Ng would explain the most common breast enhancement options. He would recommend the best breast implant surgery method used by some of the top plastic surgeons including those in Korea.

        SWENG Plastic Aesthetic and Reconstructive Surgery. All rights reserved.
        SWENG Pte Ltd. All rights reserved.

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